Operate, actions

Actions

Downstream actions derived from the resolved identities. Proposed actions wait for an operator; suppressed actions wait for a steward decision.

Eligibility engine
1,339
Eligibility conflict resolved
1,339 proposed
Claims processor
9,112
Orphan claim re-pointed
9,112 executed
Outreach
7,319
Outreach address corrected, Outreach suppressed pending steward
2,993 proposed4,326 held
Next-best-action
3,896
Care coordination outreach, New member onboarding
3,896 proposed
Member services
4,974
Duplicate member record retired
4,974 executed

Actions

26,640 derived from the last resolution run

TypeAllOrphan claim re-pointed9,112
StatusAllProposed8,228Executed14,086Held4,326Released0
ActionTypeTitleDetailLinked toStatusExecuted
ACT-001690
Orphan claim re-pointed
Claims processor
CLM-431801 → UHC-68365-96 (Ann Alvarado)
Member id
UHC-68365-96
Confidence
1
Method
probabilistic
MBR-023244CLM-431801
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001691
Orphan claim re-pointed
Claims processor
CLM-410388 → UHC-20902-98 (Jeremy Cook)
Member id
UHC-20902-98
Confidence
0.97
Method
deterministic
MBR-012010CLM-410388
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001692
Orphan claim re-pointed
Claims processor
CLM-424061 → UHC-10104-58 (Luis Jones)
Member id
UHC-10104-58
Confidence
0.97
Method
deterministic
MBR-022603CLM-424061
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001693
Orphan claim re-pointed
Claims processor
CLM-413004 → UHC-54709-71 (Mateo Barnes)
Member id
UHC-54709-71
Confidence
1
Method
probabilistic
MBR-012219CLM-413004
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001694
Orphan claim re-pointed
Claims processor
CLM-427949 → UHC-54097-94 (Lauren Howard)
Member id
UHC-54097-94
Confidence
1
Method
probabilistic
MBR-031234CLM-427949
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001695
Orphan claim re-pointed
Claims processor
CLM-429625 → UHC-46672-95 (Sue Williams)
Member id
UHC-46672-95
Confidence
0.97
Method
deterministic
MBR-002070CLM-429625
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001696
Orphan claim re-pointed
Claims processor
CLM-427534 → UHC-81174-40 (Christian Meyer)
Member id
UHC-81174-40
Confidence
1
Method
probabilistic
MBR-008776CLM-427534
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001697
Orphan claim re-pointed
Claims processor
CLM-410267 → UHC-53781-65 (Michael Evans)
Member id
UHC-53781-65
Confidence
0.97
Method
deterministic
MBR-031146CLM-410267
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001698
Orphan claim re-pointed
Claims processor
CLM-424532 → UHC-44026-65 (Bryan Hanson)
Member id
UHC-44026-65
Confidence
1
Method
probabilistic
MBR-011504CLM-424532
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001699
Orphan claim re-pointed
Claims processor
CLM-409805 → UHC-36731-44 (Dennis Greene)
Member id
UHC-36731-44
Confidence
1
Method
probabilistic
MBR-030963CLM-409805
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001700
Orphan claim re-pointed
Claims processor
CLM-429840 → UHC-94950-75 (Lauren Ramos)
Member id
UHC-94950-75
Confidence
1
Method
probabilistic
MBR-040551CLM-429840
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001701
Orphan claim re-pointed
Claims processor
CLM-424103 → UHC-36356-27 (Edward George)
Member id
UHC-36356-27
Confidence
0.97
Method
deterministic
MBR-004829CLM-424103
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001702
Orphan claim re-pointed
Claims processor
CLM-415835 → UHC-98476-18 (Kenneth Thompson)
Member id
UHC-98476-18
Confidence
1
Method
probabilistic
MBR-023075CLM-415835
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001703
Orphan claim re-pointed
Claims processor
CLM-408785 → UHC-27250-83 (Santiago Moore)
Member id
UHC-27250-83
Confidence
1
Method
probabilistic
MBR-014232CLM-408785
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001704
Orphan claim re-pointed
Claims processor
CLM-410955 → UHC-53705-72 (Noah Roberts)
Member id
UHC-53705-72
Confidence
1
Method
probabilistic
MBR-016768CLM-410955
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001705
Orphan claim re-pointed
Claims processor
CLM-418555 → UHC-31222-94 (Sara Owens)
Member id
UHC-31222-94
Confidence
1
Method
probabilistic
MBR-002276CLM-418555
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001706
Orphan claim re-pointed
Claims processor
CLM-405959 → UHC-16884-13 (David Padilla)
Member id
UHC-16884-13
Confidence
1
Method
probabilistic
MBR-013557CLM-405959
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001707
Orphan claim re-pointed
Claims processor
CLM-411066 → UHC-28897-69 (Sandra Morgan)
Member id
UHC-28897-69
Confidence
1
Method
probabilistic
MBR-023034CLM-411066
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001708
Orphan claim re-pointed
Claims processor
CLM-401734 → UHC-27338-25 (Kyle Schultz)
Member id
UHC-27338-25
Confidence
0.93
Method
probabilistic
MBR-038855CLM-401734
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001709
Orphan claim re-pointed
Claims processor
CLM-423214 → UHC-27580-31 (Ana Nunez)
Member id
UHC-27580-31
Confidence
1
Method
probabilistic
MBR-000901CLM-423214
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001710
Orphan claim re-pointed
Claims processor
CLM-409816 → UHC-52639-41 (Hiroshi Rice)
Member id
UHC-52639-41
Confidence
0.97
Method
deterministic
MBR-004166CLM-409816
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001711
Orphan claim re-pointed
Claims processor
CLM-411558 → UHC-19513-90 (Gary King)
Member id
UHC-19513-90
Confidence
1
Method
probabilistic
MBR-017229CLM-411558
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001712
Orphan claim re-pointed
Claims processor
CLM-406752 → UHC-39058-94 (Maria Robinson)
Member id
UHC-39058-94
Confidence
1
Method
probabilistic
MBR-000118CLM-406752
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001713
Orphan claim re-pointed
Claims processor
CLM-430724 → UHC-62782-53 (Mateo Salazar)
Member id
UHC-62782-53
Confidence
1
Method
probabilistic
MBR-004679CLM-430724
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001714
Orphan claim re-pointed
Claims processor
CLM-412820 → UHC-85614-59 (Hiroshi Harvey)
Member id
UHC-85614-59
Confidence
0.94
Method
probabilistic
MBR-017002CLM-412820
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001715
Orphan claim re-pointed
Claims processor
CLM-429986 → UHC-06749-57 (Raymond Wood)
Member id
UHC-06749-57
Confidence
0.97
Method
deterministic
MBR-009283CLM-429986
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001716
Orphan claim re-pointed
Claims processor
CLM-402368 → UHC-43478-17 (Charles Singh)
Member id
UHC-43478-17
Confidence
0.86
Method
probabilistic
MBR-026416CLM-402368
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001717
Orphan claim re-pointed
Claims processor
CLM-428852 → UHC-57396-21 (Deborah Richards)
Member id
UHC-57396-21
Confidence
1
Method
probabilistic
MBR-035327CLM-428852
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001718
Orphan claim re-pointed
Claims processor
CLM-422357 → UHC-60709-46 (Bruce Bradley)
Member id
UHC-60709-46
Confidence
1
Method
probabilistic
MBR-014558CLM-422357
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001719
Orphan claim re-pointed
Claims processor
CLM-432226 → UHC-99920-82 (Nicole Coleman)
Member id
UHC-99920-82
Confidence
1
Method
probabilistic
MBR-019483CLM-432226
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001720
Orphan claim re-pointed
Claims processor
CLM-409300 → UHC-88385-96 (Raymond Campbell)
Member id
UHC-88385-96
Confidence
1
Method
probabilistic
MBR-001607CLM-409300
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001721
Orphan claim re-pointed
Claims processor
CLM-417721 → UHC-73218-61 (Joseph Wheeler)
Member id
UHC-73218-61
Confidence
1
Method
probabilistic
MBR-027694CLM-417721
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001722
Orphan claim re-pointed
Claims processor
CLM-402366 → UHC-92649-44 (Roger Crawford)
Member id
UHC-92649-44
Confidence
0.99
Method
probabilistic
MBR-000491CLM-402366
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001723
Orphan claim re-pointed
Claims processor
CLM-424832 → UHC-65868-91 (Joe Weaver)
Member id
UHC-65868-91
Confidence
1
Method
probabilistic
MBR-008077CLM-424832
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001724
Orphan claim re-pointed
Claims processor
CLM-407598 → UHC-74481-70 (Beverly Phillips)
Member id
UHC-74481-70
Confidence
1
Method
probabilistic
MBR-006005CLM-407598
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001725
Orphan claim re-pointed
Claims processor
CLM-414802 → UHC-71698-36 (John Lynch)
Member id
UHC-71698-36
Confidence
1
Method
probabilistic
MBR-022288CLM-414802
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001726
Orphan claim re-pointed
Claims processor
CLM-416689 → UHC-57264-54 (Heatheer George)
Member id
UHC-57264-54
Confidence
0.99
Method
probabilistic
MBR-037750CLM-416689
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001727
Orphan claim re-pointed
Claims processor
CLM-428585 → UHC-76545-20 (Wayne Dunn)
Member id
UHC-76545-20
Confidence
0.99
Method
probabilistic
MBR-039232CLM-428585
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001728
Orphan claim re-pointed
Claims processor
CLM-419435 → UHC-97068-21 (Jonathan Silva)
Member id
UHC-97068-21
Confidence
1
Method
probabilistic
MBR-004663CLM-419435
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001729
Orphan claim re-pointed
Claims processor
CLM-411499 → UHC-74308-55 (Jack Clark)
Member id
UHC-74308-55
Confidence
0.97
Method
deterministic
MBR-000732CLM-411499
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001730
Orphan claim re-pointed
Claims processor
CLM-416785 → UHC-71651-40 (Vincent Santiago)
Member id
UHC-71651-40
Confidence
0.99
Method
probabilistic
MBR-026351CLM-416785
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001731
Orphan claim re-pointed
Claims processor
CLM-416917 → UHC-34595-03 (Carol Wheeler)
Member id
UHC-34595-03
Confidence
1
Method
probabilistic
MBR-001828CLM-416917
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001732
Orphan claim re-pointed
Claims processor
CLM-400462 → UHC-62709-80 (David Coleman)
Member id
UHC-62709-80
Confidence
1
Method
probabilistic
MBR-018534CLM-400462
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001733
Orphan claim re-pointed
Claims processor
CLM-401089 → UHC-64189-42 (Amy Vargas)
Member id
UHC-64189-42
Confidence
1
Method
probabilistic
MBR-009608CLM-401089
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001734
Orphan claim re-pointed
Claims processor
CLM-428158 → UHC-56916-28 (Logan Larson)
Member id
UHC-56916-28
Confidence
0.97
Method
deterministic
MBR-019372CLM-428158
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001735
Orphan claim re-pointed
Claims processor
CLM-403812 → UHC-53289-31 (Deborah Bishop)
Member id
UHC-53289-31
Confidence
0.85
Method
probabilistic
MBR-022384CLM-403812
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001736
Orphan claim re-pointed
Claims processor
CLM-423017 → UHC-07292-09 (Jen Cooper)
Member id
UHC-07292-09
Confidence
1
Method
probabilistic
MBR-028506CLM-423017
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001737
Orphan claim re-pointed
Claims processor
CLM-412840 → UHC-15044-36 (Ryan Grant)
Member id
UHC-15044-36
Confidence
1
Method
probabilistic
MBR-006882CLM-412840
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001738
Orphan claim re-pointed
Claims processor
CLM-429110 → UHC-44226-46 (Christopher Stevens)
Member id
UHC-44226-46
Confidence
0.97
Method
deterministic
MBR-014505CLM-429110
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001739
Orphan claim re-pointed
Claims processor
CLM-405988 → UHC-80866-65 (Diego Baker)
Member id
UHC-80866-65
Confidence
1
Method
probabilistic
MBR-030953CLM-405988
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 8 of 183PreviousNext

Derivation rules

Evaluated after every gold rebuild

  1. 1
    Eligibility conflict resolved
    The records behind one identity disagree on plan code. Survivorship picks the enrollment plan; the eligibility engine is told which one is canonical.
  2. 2
    Orphan claim re-pointed
    A claim arrived without a member ID. Resolution attached it to an identity that has one, so the claims processor can now pay it against the right member.
  3. 3
    Outreach address corrected
    The most recent address on the golden record differs from what enrollment holds. Outreach gets the current address before the next mailing.
  4. 4
    Outreach suppressed pending steward
    The record is sitting in an open steward case. Nothing sensitive is sent until a person decides, so we never message the wrong member.
  5. 5
    Care coordination outreach
    Three or more claims and no provider record. Next-best-action proposes assigning a PCP and scheduling a care-coordination call.
  6. 6
    New member onboarding
    A single, fresh enrollment with no other activity yet. Next-best-action proposes the welcome kit and a digital ID card.
  7. 7
    Duplicate member record retired
    Two or more enrollment records collapsed into one identity. Member services retires the extra cards against the surviving member ID.